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. 2015 Mar:64:92-6.
doi: 10.1016/j.jcv.2015.01.013. Epub 2015 Jan 21.

Effect of intravenous immunoglobulin for neonates with severe enteroviral infections with emphasis on the timing of administration

Meng-Hsiu Yen  1 , Yhu-Chering Huang  2 , Min-Chi Chen  3 , Ching-Chuan Liu  4 , Nan-Chang Chiu  5 , Reyin Lien  6 , Luan-Yin Chang  7 , Cheng-Hsun Chiu  6 , Kuo-Chien Tsao  8 , Tzou-Yien Lin  9
Affiliations

Effect of intravenous immunoglobulin for neonates with severe enteroviral infections with emphasis on the timing of administration

Meng-Hsiu Yen et al. J Clin Virol. 2015 Mar.

Abstract

Background: The benefits of intravenous immunoglobulin (IVIG) therapy for severe neonatal enterovirus infections are still controversial.

Object: To evaluate whether timing of IVIG administration might affect clinical outcomes of neonates with severe enteroviral infections.

Study designs: We retrospectively analyzed 67 neonates with culture-confirmed severe enteroviral infection, defined as hepatitis with coagulopathy and thrombocytopenia. Clinical features, outcomes and the usage of IVIG therapy were collected and analyzed. IVIG administered within 3 days of illness onset was classified as early IVIG therapy.

Results: Of the 67 cases, 38 (57%) were male, 27 (40%) were premature, 57 (85%) had disease onset within 7 days of life and all but 2 cases were caused by coxsackievirus B group. Ten infants (15%) had clinically evident myocarditis. 41 infants (61%) received IVIG therapy and 29 were early IVIG therapy. Fifteen infants (22%) eventually died, without IVIG therapy for 7 infants. The deceased had a significantly higher peak serum aspartate aminotransferase (AST) level than the survivors (3539 vs. 866 IU/L, p<0.01). The timing of IVIG therapy was highly correlated with the timing of peak AST level in patients with early IVIG therapy. Multiple logistic regression analysis showed that a higher nadir hemoglobin level (adjusted odds ratio 2.8, 95% confidence interval: 1.4-5.4), no concurrent myocarditis (42.6 [3.4-5289]) and early IVIG therapy (14.7 [1.3-163]) were independently associated with a favorable prognosis.

Conclusions: In defined severe neonatal enterovirus infections, serum AST level correlated with the disease severity. Early IVIG therapy, if needed, may be beneficial for survival.

Keywords: Enterovirus; Hepatitis; Intravenous immunoglobulin; Myocarditis; Neonates.

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